Healthcare Provider Details

I. General information

NPI: 1265592059
Provider Name (Legal Business Name): JANE B WRENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MARION ST
COLUMBIA SC
29201-2113
US

IV. Provider business mailing address

1038 ORANGEBURG DR
WEST COLUMBIA SC
29169-2344
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-0123
  • Fax: 803-898-0166
Mailing address:
  • Phone: 803-957-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number59869
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: